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Topic: POS issue (Read 4563 times)

In my situation I bill CPT 95951 TC with (12) the patients home. Medicare rejects the claim due to improper place of service, yet Medicaid pays out in this situation. The professional and global codes are both acceptable with Medicare in the patients home. It seem that only the technical component is denied.

My whole business is built around providing the patient with convenient in home care. I'm wondering if this is an error .. Any ideas?

We have come across a similar situation with a different code. Our dr goes into the nursing home to see patients. He brings in the machine and does global services for the procedure but he can only bill Medicare for the PC with the POS 31. However, Medicaid pays for both TC & PC so we bill them global. We have talked to Medicare about it but they say there is nothing we can do. That is just their policy. I'm going to assume it's the same. So in answer to your question, Yes, it is common for a POS to work with Medicaid but not Medicare.

I have not gone through that process. The code that I was referring to is a just a small test, not a big part of the overall service so the doctor just bills the PC to Medicare. I will have to take a look at it though.

I am not a neuro biller but I am familiar with the procedure. Perhaps you can explain to me..(not a challenge question, just curious) how do you do the video part of the procedure in the patient's home? I have a grandchild that just went through this and was hospitalized so just curious if all of the components of this can be performed in the home setting. Again..only asking for an explanation if you would be willing to explain..curious how that would work.

We have a high tech zoom, auto focus camera with infrared that we place in a room in the patients house. This camera is attached to a lap top which syncs the brainwaves from the wireless headbox to the video. We just ask that the patient spend most of their time in that room, then remotely monitor the patient from a separate computer.

It's obviously not the ideal setting for adjusting medication levels in epileptics, but it's great for speudo-seizure, anxiety attacks, twitches etc. It's also way less expensive.

Well I spent the morning speaking to Medicare. I started with the national level, was given some advice and told to speak with my local medicare service provider. She was absolutely no help other than giving me a link to a POS descriptions page (which I already had). She then told me she can't tell me which POS are acceptable with 95951 TC (12) because she isn't a coder and cannot tell me how to bill my patients, even though they are the only insurance company who doesn't allow this.

So I'm no closer to finding an answer and even more frustrated than before. I guess that's what happens in this business. I have a new respect for you coders. It seems so frustrating and confusing since there are likely variations with every insurance company.

We just ask that the patient spend most of their time in that room, then remotely monitor the patient from a separate computer.

And where, pray tell, is that separate computer located - from which you are actually doing the TC part of the test? I'm guessing it is not in the home? Voila, the home is not the "place of service" for the TC part of the test.